Objective To investigate the association between serum level of secretory type Ⅱ phospholipase A2 (sPLA2 Ⅱ a) and carotid intima-media thickness (CIMT) in elderly patients with metabolic syndrome (MS).Methods A total of 124 consecutive MS patients aged over 65 years were enrolled and another 90 elderly non-MS subjects were served as controls.The serum concentration of sPLA2 Ⅱ a was measured by enzyme-linked immunosorbent assay.Blood pressure,blood lipids and blood glucose levels etc.were also measured.The carotid intima-media thickness was examined by color Doppler ultrasonography.Results Serum level of sPLA2 Ⅱ a was significantly higher in elderly MS patients than in control group [(4.41±1.55)μg/L vs.(2.39±0.97)μg/L,P＜ 0.05].Compared with the control group,elderly MS patients showed CIMT was significantly increased [(1.17±0.24) mm vs.(0.89±0.24)mm,P＜0.05].Serum level of sPLA2 Ⅱ a were higher in elderly obesity patients than in normal BMI subjects [(4.76±0.99)μg/L vs.(2.84±0.54)μg/L,P＜0.05].Multiple regression analysis indicated that sPLA2 Ⅱ a level was an independent risk factor for CIMT in elderly MS patients after adjusting for the effects of BMI,IL-6 and high sensitive C-reactive protein (hs CRP) on CIMT(r=0.38,P＜0.01).Conclusions Serum level of sPLA2 Ⅱ a is increased in elderly MS patients and is independently correlated with CIMT,which has a predictive value for atherosclerosis,sPLA2 Ⅱ a may be involved in the process of vascular endothelial injury.